Provider Demographics
NPI:1942833165
Name:BYSHEIM, KIMBERLY (CRNP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:BYSHEIM
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 HOLLY WOODS DR
Mailing Address - Street 2:
Mailing Address - City:LUSBY
Mailing Address - State:MD
Mailing Address - Zip Code:20657-4144
Mailing Address - Country:US
Mailing Address - Phone:410-474-5251
Mailing Address - Fax:301-290-1510
Practice Address - Street 1:28105 THREE NOTCH RD # 1C
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20659-3235
Practice Address - Country:US
Practice Address - Phone:301-290-1510
Practice Address - Fax:301-290-1574
Is Sole Proprietor?:No
Enumeration Date:2020-02-17
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR206634363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty